Billing Manual for Community Care Network Providers

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Current patients or clients or the parents of patients under the age of 14 shall benotified of the specific conditions under which information may be released withouttheir consent.Information made available under this section shall be limited to that informationrelevant and necessary to the purpose for which the information is sought. Theinformation may not, without the patient’s consent, be released to additionalpersons, or entities, or used for additional purposes. Requests for information andthe action taken should be recorded in the patient’s records.Release to CourtsEach facility director shall designate one or more persons as a records officer, whoshall maintain the confidentiality of client/patient records in accordance with thischapter.Records shall comply with the following:• Whenever a client/patient’s records are subpoenaed or otherwise made subjectto discovery proceedings in a court proceeding, other than proceedingsauthorized by the act, and the patient/client has not consented or does notconsent to release of the records, no records should be released in the absenceof an additional order of the court.• The records officer, or his designee, is to inform the court either in writing or inperson that, under statute and regulations, the records are confidential andcannot be released without an order of the court. Neither the records officer northe facility director has any further duty to oppose a subpoena beyond stating tothe court that the records are confidential and cannot be released without anorder of the court; however, nothing in this section shall be construed asauthorizing such a court order.• If it is known that a patient has a current attorney or record for the givenproceedings, that attorney shall be informed of the request of subpoena, if notalready served with a copy, and shall be expected to represent and protect theclient/patient’s interests in the confidentiality of the records. The person whoserecord has been subpoenaed shall be notified of such action if they are currentlyreceiving services and their whereabouts are known, unless served with a copyof the subpoena. Those currently in treatment shall also be advised that theymay wish to obtain an attorney to represent their interests. In the case of personsno longer receiving services, the facility shall send this notification by certifiedmail to the last known address.• If a present or former patient sues a person or organization providing servicessubject to the act in connection with said patient’s care, custody, evaluation, ortreatment, or in connection with an incident related thereto, defense counsel forsaid service provider shall have such access to the present or former patient’srecords as such counsel deems necessary in preparing a defense. Counselreceiving such records shall maintain their confidentiality and shall limit thedisclosure of the contents thereof to those items they deem necessary to allowcounsel to prepare and present a proper defense.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 164
• All employees of a facility shall be informed of the rules and regulations regardingconfidentiality of records and shall also be informed that violation of them couldpotentially subject them to civil or criminal liability. Training for employeesregarding confidentiality remains the responsibility of the facility director.Departmental Access to Records and Data CollectionNotwithstanding, any part of this chapter to the contrary, employees of thedepartment shall not be denied access to any patient records where such access isnecessary and appropriate for the employee’s proper performance of his/her duties.The facility director shall make such decision, and shall be responsible for limitingaccess to those portions, which are relevant to the request.Any conflict as to access by an employee to patient records at State Hospitals shallbe resolved by the Regional Commissioner of Mental Health.Collection and analysis of clinical or statistical data by the department, theadministrator, or the facility for administrative or research purposes may beundertaken as long as the report or paper prepared from the data does not identifyany individual patient without his consent.Child or Patient AbuseNothing in this chapter shall conflict with the mandatory statutory or regulatoryrequirements of reporting suspected or discovered child abuse or patient abuse.Whenever a conflict exists between the reporting requirements of the Child ProtectiveServices Act (11 P.S. §§ 22012224), and the confidentiality of mental health records,the reporting requirements shall govern.Release of Information related to Drug and Alcohol Dependency and TreatmentCommunity Care complies with the Pennsylvania Drug and Alcohol Abuse Control Actand applicable State regulations at 4 PA. Code §255.5(b) and Interpretative Guidelinesissued by the Pennsylvania Department of Health, and federal regulations at 42 C.F.R.,Part 2, concerning circumstances of permissible release of records containinginformation on alcohol and substance abuse and dependency.All member records containing information as to drug and alcohol abuse or dependencyand treatment must be kept confidential. Such records may be disclosed only with themember’s authorization and only (I) to medical personnel exclusively for purposes ofdiagnosis and treatment of the member or (II) to government agencies exclusively forthe purpose of obtaining benefits due as a result of such drug or alcohol abuse ordependency.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 165
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APPENDIX A.2. Confidentiality 130AP
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Clinical Fax by County:Adams 1-866-
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Outpatient Therapy 1MD OutpatientMe
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Functional Familytherapy (FFT)Multi
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Non-Acute PartialHospitalizationNot
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I.A. Code of EthicsCommunity Care
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esources and evaluated on their pro
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Confidentiality policies including
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Within 30 minutes for urban areas.W
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I.E. Care Management Team“Advocat
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In order to serve special populatio
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Psychiatric Rehabilitation Clubhous
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always be considered in light of th
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Tell their provider everything they
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and calls received on the programs
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II.D.1e EvaluationIndividuals parti
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II.D.2b GoalsThe goals of Community
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II.D.3 Providers’ Role in the Pre
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Community Care has a total of 30 ca
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Department of Health and provide in
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An explanation of the grievance pro
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Upon request, the member will be as
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Notices must be in alternate format
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Community Care is a party to the he
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The following sections provide info
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members, practitioners are asked to
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Accreditation of Healthcare Organiz
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III.B.4 Facility ReassessmentFacili
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present relevant information, and t
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contracting, performance evaluation
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the implementation and application
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III.C.4 Ability to Give Informed Au
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When such disclosure to health care
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Practitioners are informed of the r
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Medication(s) that have been prescr
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III.E. Clinical Practice Guidelines
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Community Care has developed a plan
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eing served and uses strategies to
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dialogue and intervention may occur
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For any questions about providing s
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If you, as a Community Care provide
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When the precertification is for se
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ORA member expresses a readiness fo
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IV.E.3 Transition of Care to anothe
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Billing ManualCommunity Care Behavi
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Even though an authorization may be
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Timely File requests are to be mail
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Provide an alternative to the use o
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Required Claim FieldsIn the followi
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24C EMG Not required24D Procedure C
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17 Discharge Status Required forINP
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67a-q Diag. Code Required68 Unlabel
Page 114 and 115: • Explanation of Benefits (EOB) i
Page 116 and 117: Many of the services covered by Com
Page 118 and 119: Community Care Behavioral Health Or
Page 120 and 121: Community Care Procedure Code: The
Page 122 and 123: C/FST: Consumer/Family Satisfaction
Page 124 and 125: Medicaid/Medical Assistance identif
Page 126 and 127: APPENDICESAPPENDIX A.1. Fraud, Wast
Page 128 and 129: . The provider will also receive a
Page 130 and 131: APPENDIX A.2. ConfidentialityPOLICY
Page 132 and 133: A Facility or group practice name,
Page 134 and 135: Confidential data and information s
Page 136 and 137: The medical director or his/her des
Page 138 and 139: The privacy officer will review the
Page 140 and 141: collection and use of member identi
Page 142 and 143: Protection of information disclosed
Page 144 and 145: If a member is granted access to re
Page 146 and 147: Under some circumstances, it may be
Page 148 and 149: 164.504(e)(ii)(A)).They will take a
Page 150 and 151: must verify that the member has sig
Page 152 and 153: esults, billing records, and treatm
Page 154 and 155: equestor destroy the information, o
Page 156 and 157: The member has the right to request
Page 158 and 159: Policy on Release of Information Re
Page 160 and 161: y the written authorization of the
Page 162 and 163: If minor consents to treatment or c
Page 166 and 167: If the client has given written aut
Page 168 and 169: Confidentiality policies pursuant t
Page 170 and 171: “Statement of Confidentiality”
Page 172 and 173: Findings will be reported to senior
Page 174 and 175: information and by signing this sta
Page 176 and 177: Community Care has identified circu
Page 178 and 179: NameAddress (es)Zip CodeDiagnosis (
Page 180 and 181: Community Care has the right to den
Page 182 and 183: Member identifiable information may
Page 184 and 185: Community Care extends all reasonab
Page 186 and 187: For research purposes.On behavioral
Page 188 and 189: See the policy on Transition of Pri
Page 190 and 191: Community Care does not collect inf
Page 192 and 193: The request must be in writing. Cre
Page 194 and 195: All statements to the media includi
Page 196 and 197: • The name, or title, and the tel
Page 198 and 199: APPENDIX A.4. Significant Member In
Page 200 and 201: Orientation and ongoing provider ed
Page 202 and 203: CONSENT FOR RELEASE OF INFORMATIONM
Page 204 and 205: Authorization for the Release of Dr
Page 206 and 207: ___________________________________
Page 208 and 209: APPENDIX C.1. Priority PopulationsM
Page 210 and 211: Second priority is associated with
Page 212 and 213: 3. Secondary Data - OMHSAS will dev
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BEHAVIORAL HEALTH MANAGED CARE ORGA
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APPENDIX E.1. Companion Guide for N
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Billing Manual for Community Care Network Providers

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